Trapezium fractures are uncommon carpal bone injuries. They can either occur in isolation or combination with another carpal bony injury.
They can be broadly classified into ridge (most common 2) and body fractures.
They often occur as a result of a high energy trauma and usually involves either direct or indirect axial loading 1. These are most commonly transverse loading injuries in the setting of an adducted thumb in which the first metacarpal is driven into the trapezium 5.
Trapezial ridge fractures may result from a direct blow to the volar surface, dorsoradial impaction or an avulsion injury. Fractures of the trapezial body result from an axial loading or shearing force through the first carpometacarpal joint.
Trapezial fractures are often associated with a fracture of the first metacarpal base and/or subluxation or dislocation of the first carpometacarpal joint.
Trapezial ridge fractures may be associated with wrist injuries, including distal radial fractures.
Non displaced fractures can sometimes be occult. A Robert’s AP view, with the hand in full pronation, is a good way of visualising the trapezium on plain radiographs. If the diagnosis is still in question, a CT or bone scintigraphy could be considered.
Trapezial ridge fractures may be overlooked at routine wrist radiography. Carpal tunnel radiographs may be helpful to detect this fracture 2, whereas CT imaging can be diagnostic.
Treatment and prognosis
Displaced fractures may require open reduction and internal fixation, typically performed with Kirschner wires or screws.
If corticated, consider accessory ossicles in this region such as
- 1. Ramoutar DN, Katevu C, Titchener AG et-al. Trapezium fracture - a common technique to fix a rare injury: a case report. Cases J. 2009;2 : 8304. doi:10.4076/1757-1626-2-8304 - Free text at pubmed - Pubmed citation
- 2. Kaewlai R, Avery LL, Asrani AV et-al. Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics. 2008;28 (6): 1771-84. doi:10.1148/rg.286085511 - Pubmed citation
- 3. Wiesler ER, Chloros GD, Kuzma GR. Arthroscopy in the treatment of fracture of the trapezium. Arthroscopy. 2007;23 (11): 1248.e1-4. doi:10.1016/j.arthro.2006.07.051 - Pubmed citation
- 4. Schmitt R, Lanz U. Diagnostic Imaging of the Hand. George Thieme Verlag. (2008) ISBN:3131405813. Read it at Google Books - Find it at Amazon
- 5. Goldfarb CA et.al. Wrist Fractures: What the Clinician Wants to Know1. Radiology. 2001;219 (1): 11-28. Radiology (full text)
Wrist and hand fractures
- wrist and hand fractures (Amsterdam wrist rules)
- distal radial fracture (Frykman classification)
- distal ulna fractures
- fracture dislocations of the radius and ulna
- carpal fractures
- metacarpal fractures
- phalanx fractures
- stress fracture
- pathological fracture
- fracture location
- fracture types
- fracture displacement
- skull fractures
- fractures involving a single facial buttress
- complex fractures
- cervical spine fracture classification systems
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
- spinal fractures by region
- cervical spine fractures
- thoracic spine fractures
- lumbar spine fractures
- sacral fractures
- spinal fracture types
- rib fractures
upper limb fractures
- Rockwood classification (acromioclavicular joint injury)
- Neer classification (proximal humeral fracture)
- AO classification (proximal humeral fracture)
- Mason classification (radial head fracture)
- Frykman classification (distal radial fracture)
- Mayo classification (scaphoid fracture)
- Hintermann classification (gamekeeper's thumb)
- upper limb fractures by region
- carpal bones
- pelvic fractures
- lower limb fractures
- lower limb fractures by region
- femoral head fracture
- subcapital fracture
- cervical fracture
- intertrochanteric fracture
- pertrochanteric fracture
- femoral shaft fracture
- tibial shaft fracture
- fibular shaft fracture
- Maisonneuve fracture